2019-2020 Dharma School Registration
Dharma School registration fee is $150 per child for Dharma Rain member families and $300 for non-member families. Some scholarships are available.  
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Youth's First Name *
Youth's Last Name *
Youth's Birth Date *
MM
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DD
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YYYY
Gender *
Grade Entering Fall 2019 School Year *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian First Name
Parent/Guardian Last Name
Street Address *
City *
State *
Zip *
Parent/Guardian email *
Parent/Guardian Phone *
Parent/Guardian email
Parent/Guardian Phone
Are you currently a member of Dharma Rain Zen Center?
When you make a pledge of $15 or more per month, you receive the benefits of membership. Membership benefits include: reduced fees for Dharma School, reduced fees for many other programs including sesshin, use of the library and the right to vote during Board of Director elections. Go to https://dharma-rain.org/getting-involved/membership/ to learn more about membership and become a member.
Current Membership *
The next two questions are for youth and families
We understand that this is a Buddhist Sunday program and we want to have some fun while learning to do Buddhist practice. *
We have been learning about Buddhism at home and/or at a temple *
In case of emergency, parents/guardians will be notified first. Please list two ADDITIONAL emergency contacts.
Emergency Contact #1 Name, relationship and Phone Number (NOT Parent/Guardian listed above) *
Emergency Contact #2 Name, relationship and Phone Number (NOT Parent/Guardian listed above) *
Does the youth have medical insurance? *
Does the youth have dental insurance? *
Health History: Does the young person have a medical or mental health condition that a doctor or medical professional should be informed of in case of emergency? Please be specific. *
Drug allergy? If yes, please describe. *
Food allergy? If yes, please describe. *
Chronic or recurring illness? If yes, please describe. *
Need to take medication regularly? If yes, please describe. *
Other: Please tell us of any special concerns you have about the youth's comfort and what might interfere with the success of Dharma School experience. We would appreciate insight into the strengths, weaknesses, and/or idiosyncrasies of the young person's character and physical being. *
The youth may be given any and all medical treatment deemed proper and necessary by an attending physician in case of emergency. *
I understand that pictures and videos may be taken during Dharma School or other Dharma Garden programs. I hereby give permission for the use of such images of my youth for the promotion of Mandala on the Mountain and/or Dharma Rain Zen Center. I understand that children are never identified by name in publications, unless by express permission of the parent(s)/guardians(s) (and child, if old enough to object). *
Please include our family's information in the Dharma School Family Directory. The Directory will list names of parents, children, class groups and email addresses of parents. Inclusion in the Dharma School Family Directory is optional.
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I have filled out this form fully and accurately to the best of my knowledge. I agree to release Northwest Zen Sangha, Dharma Rain Zen Center, and the staff of Dharma School from any liabilities that might accrue from reasonable and normal activities during the time my child is in their care. My questions about Dharma School, Dharma Garden programs, and/ or overnight participation have been satisfactorily answered.
Name of person filling out this form, and date *
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